tbuckley/cabot-search huggingface dataset:
Point-of-care isoenzyme type M2 pyruvate kinase quick stool test for the detection of gastric cancer in Rwanda: A pilot study.
Authors: Ivy Riano, Felicien Shikama, Marie Solange Mukanumviye, Zainab Ingabire, Dyna Nyampinga, Victoria Forbes, Mary D. Chamberlin, Hanna Aberra
Journal: Journal of Clinical Oncology (2023)

e18530 Background: Isoenzyme type M2 pyruvate kinase (M2-PK) can only be detected in gastrointestinal (GI) tumors. Detection of M2-PK on a small, portable platform with minimal training required, could offer a streamlined approach for the diagnosis of GI cancers especially in low-income countries (LIC's). We evaluated the feasibility of M2-PK stool test to detect gastric cancer in Rwanda. Methods: Participants with GI symptoms were screened and scheduled for upper endoscopy during the 5 th Annual Rwanda Endoscopy Week. Participants who underwent gastric biopsy and provided a stool sample were enrolled. Three Rwandan medical centers participated. ScheBo M2-PK Quick test (Biotech AG, Giessen, Germany) was used to test fecal tumor M2-PK. Study approval was obtained from Dartmouth Health, UConn Health, and University of Rwanda IRB's. Descriptive statistics were estimated. Study is currently enrolling patients to reach the desired sample size (N = 110). Results: A total of 35 patients were consented; 26 patients did not have a biopsy, 1 did not provide a stool sample, 1 was lost to follow-up, and 7 were analyzable. 57.1% were male (n = 4) and 42.9% females (n = 3) with ages ranging from 50 to 71 years old. Males accounted for 66.6% of the cases of gastric cancer (n = 2). The most predominant symptoms reported were dyspepsia (66.7%), and weight loss (33.3%). Among those with hemoglobin levels available the mean was 8.63 g/dL (SD ± 0.71). Only one patient completed staging imaging with CT scans. Two patients with positive M2-PK stool tests had a proven diagnosis of gastric cancer (100%). One of them had a diagnosis of GIST. There was only 1 confirmed gastric adenocarcinoma in 5 patients with a negative M2-PK stool test, yet two patients were told to repeat the endoscopy procedure. Conclusions: A point-of-care (POC) quick stool test to screen gastric cancer is feasible in Rwanda. Study participation interest was high among Rwandan patients. Due to a lack of flexible endoscopes in LIC's, screening is restricted to patients living near regional or urban endoscopy centers, which contributes to the growing prevalence of gastric cancer and health disparities. Cancer control programs in LIC's can be implemented and maintained iteratively with realistic expectations and interventions tailored to the local population, its cultural values, and economic infrastructure. Thus, an emerging POC M2-PK stool test can triage patients to early medical attention when suspected gastric cancer.
Disparities in medical oncology visit adherence among African American (AA) men with prostate cancer (pCa).
Authors: Ariel Ann Nelson, Christina Ladwig, Kristin Riemersma, Kathryn A. Bylow, Deepak Kilari
Journal: Journal of Clinical Oncology (2023)

e18671 Background: AA patients (pts) with pCa tend to have worse outcomes when compared to Caucasians. Disparities in access to healthcare among AA pts with pCa is a significant barrier to improvement in outcomes. Medical oncology visit attendance among this population has not been thoroughly investigated. Methods: Pts with a diagnosis (dx) of pCa scheduled to see a provider (MD or advanced practice provider) at a single academic institution medical oncology clinic between January 2022 and December 2022 were retrospectively identified. Pts were categorized by self-identified race. The total number of scheduled clinic visits was recorded, and each visit was categorized by visit status; completed, cancelled, no-show, or left clinic. The reason for visit cancellation was assessed and cancelled visits for non-pt driven reasons (ie. scheduling error) were removed. The data were summarized using descriptive statistics. Z-test and Chi-square analysis were utilized to compare proportions of visits between AA and Caucasian pts and the association of race with visit status. Results: A total of 992 pts were selected, 80% (n = 792) were Caucasian and 16% (n = 162) were AA, representing 4231 clinic visits during the study period. AA pts accounted 18% (n = 763) of the total scheduled visits. 94% of visits (n = 3962) were follow up and 6% (n = 269) were new pt visits. 86% of all scheduled visits were completed and 10 % (n = 436) were cancelled for pt driven reasons. Roughly 3% (n = 135) of visits were no-show. AA pts had fewer completed visits compared to Caucasian pts, 78% vs 88% (p &lt; 0.001) and a higher no-show rate of 10% vs 1.5% (p &lt; 0.001). The cancellation rate was similar between AA and Caucasian pts, 11% vs 10% (p = 0.33). The combined no-show and cancellation rate for AA pts was 22% vs 12% for Caucasian pts (p &lt; 0.001). There was a significant association between AA race and no-show visit status (p &lt; 0.001). Conclusions: AA men with pCa have much poorer visit adherence to scheduled medical oncology visits compared to their Caucasian counterparts. Identifying reasons for no-show and visit cancellations and targeted interventions to improve access to care are needed to improve outcomes. [Table: see text]
Antitumor activity of olverembatinib (HQP1351) in patients (pts) with tyrosine kinase inhibitor (TKI)–resistant succinate dehydrogenase (SDH)–deficient gastrointestinal stromal tumor (GIST).
Authors: Haibo Qiu, Zhi-wei Zhou, Ye Zhou, Xiangbin Wan, Ning Li, Kaixiong Tao, Yong Li, Xin Wu, Zi Chen, Lihui Liu, Lichuang Men, Hengbang Wang, Eric Liang, Cunlin Wang, Lixin Jiang, Dajun Yang, Rui-Hua Xu, Yifan Zhai
Journal: Journal of Clinical Oncology (2023)

11540 Background: Treatment of pts with GIST has been transformed by TKIs. However, treatment resistance is a challenge in managing locally advanced or metastatic disease. Pts with SDH-deficient GIST typically present with multifocal and multinodular disease that is insensitive to most TKIs. Olverembatinib is an investigational novel, potent, orally active third-generation TKI with promising activity against GIST in multiple preclinical models. Methods: The aim of this study was to evaluate the safety and efficacy (per RECIST v1.1) of olverembatinib in pts with TKI-resistant metastatic SDH-deficient GISTs (confirmed by immunohistochemistry). Olverembatinib was administered orally once every other day (QOD) in 28-day cycles. Results: As of January 15, 2023, 20 pts with SDH-deficient GIST had received ≥ 1 dose of olverembatinib (median age, 30 [14-56] years), and 19 had received 1 to TKIs (50% of pts ≥ 3; Table). The dose range of olverembatinib was 20 to 50 mg (50 mg cohort [n = 6]; 40 mg [n = 8]; 30 mg [n = 6]). The median (range) treatment duration was 7.8 (1.81-42.3) months. A total of 5 of 20 pts experienced partial response (PR) as the best response. Of 16 evaluable pts treated with &gt; 4 cycles of olverembatinib, the clinical benefit rate (CBR; complete response + PR + stable disease &gt; 4 cycles) was 93.8% (15/16); the longest treatment duration was 42 months. All pts experienced treatment-emergent adverse events (AEs; most, grade 1 or 2); 2 pts experienced grade 3 AEs; the only hematologic AE with an incidence rate ≥ 20% was anemia (55%). A total of 15 (75%) pts experienced treatment-related AEs (grade 3 neutropenia [n = 1]). No treatment-related serious AEs were reported. Conclusions: Olverembatinib was well tolerated up to 50 mg QOD and showed antitumor activity in pts with TKI-resistant, SDH-deficient GIST. A total of 5 PRs were reported among 20 evaluable pts and 15 SDs among 16 pts treated for ≥ 4 cycles (98.3% CBR). These promising findings warrant further investigation. Internal study identifier: HQP1351SJ003. Clinical trial registration: NCT03594422 . [Table: see text]
Clear cell sarcoma: The OSU experience.
Authors: Gabriel Tinoco, Marium Husain, Hangil Kim, Menglin Xu, David A. Liebner
Journal: Journal of Clinical Oncology (2023)

e23554 Background: Clear cell sarcoma (CCS) is an ultra-rare translocation-driven sarcoma. Often affects young adults with no sex preponderance, and whites have a higher occurrence. Frequently present as a slow-growing mass in the extremities or trunk. The EWSR1–ATF1/CREB1 mutation is pathognomonic. The optimal treatment has not been outlined, but it is extrapolated from soft tissue sarcomas. The role of systemic therapies still needs to be fully elucidated, largely due to limited data. This is one of the largest single-institution cohorts reported. Methods: Patients evaluated at The Ohio State University James Comprehensive Cancer Center between January 1, 2010, and April 1, 2022, were included. Data collected included baseline demographic variables, pathologic and molecular features, treatment regimen, and outcomes. Due to a small cohort size, descriptive statistics were performed instead of formal power calculations. Results: A total of five patients were identified. 3 of 5 were white (60%), and 2 of 5 patients were black (40%). The mean age at diagnosis was 46 years, median at 43 years, ranging from 29 to 66 years. 3 of the 5 patients were female (60%), and 2 were male (40%). The mean size of the tumor at presentation is 5.62 cm. 2 of the 5 patients had stage 1 disease at presentation (40%), one had stage 3 (20%), and 2 had Stage 4 (40%). 3 out of 5 patients received treatment with curative intent. 4 patients had primary in the abdomen/lower back or lower extremities (80%). 4 patients received chemotherapy, and these patients received 3 to &gt; 5 cycles. 3 of the 4 on chemotherapy progressed (50%). A patient who received Sunitinib had the shortest time to progression, at 30 days (or 4.3 weeks). The patient who experienced the longest time to progression received Pazopanib, with progression occurring after 339 days (or 48 weeks). Within the early-stage patients, one of the three underwent surgery progressed (33.3%). None of the two patients that received radiation progressed (0%). 3 of 5 participants (60%) eventually expired during the study dates (2 with metastatic disease at diagnosis and 1 with localized disease). All patients received next-generation sequencing. One of these patients demonstrated positive expression levels for PD-L1. The median tumor mutation burden (TMB) value was 11.86 ranging from 2.06 to 28.16. Conclusions: We found that CCS has a high rate of disease progression despite the multimodality approach, and there is a high mortality associated with the disease. Due to the sample size of this single institution study, we cannot identify significant associations between clinical and demographic factors and treatment outcomes in clear cell sarcoma. However, these results stress the importance of multi-institutional (national and international) collaboration around ultra-rare subtypes of sarcoma to provide more significant patient data, improve outcomes, and design clinical trials for these patients.
Efficacy and safety of anlotinib combined with anthracycline and ifosfamide followed by anlotinib maintenance in advanced soft tissue sarcoma: A single-arm, phase 2 trial.
Authors: Zengjun Liu, Mengyao Liu, Jing Xu, Wenyu Hu, Dongyuan Zhu, Rongjie Tao, Ni Xu, Hui Zhang, Minghuan Li
Journal: Journal of Clinical Oncology (2023)

11553 Background: Anthracycline plus ifosfamide is the standard first line treatment regime for advanced soft tissue sarcoma (STS). Anlotinib, a multikinase angiogenesis inhibitor, has evolved as a standard second line treatment option in Chinese advanced STS patients. This study was performed to evaluate the efficacy and safety of anlotinib combined with anthracycline and ifosfamide followed by anlotinib maintenance in the first line treatment of patients with advanced STS. Methods: This prospective, open-label, single-arm, phase 2 trial was conducted in Shandong Cancer Hospital and Institute (ChiCTR2100054711). The key inclusion criteria included: (a) age was 18-70 years; (b) ECOG performance state of 0-1; (c) histologically confirmed high-grade STS; (d) unresectable or metastatic STS; (e) previously untreated, and sensitive to chemotherapy; (f) having measurable lesions according to RECIST 1.1. All patients received up to 6 cycles of anlotinib (12 mg QD on day1-14, 21 days per cycle) combined with anthracycline (epirubicin 40mg/m 2 /d on day 1-2, 21 days per cycle; or liposomal doxorubicin 30mg/m 2 /d on day 1, 21 days per cycle) and ifosfamide (2g/m 2 /d on day 1-3, 21 days per cycle) followed by anlotinib maintenance until disease progression, unacceptable toxicity or death. Pegylated recombinant human granulocyte colony-stimulating factor was administered following chemotherapy. The primary endpoint was objective response rate (ORR). The secondary endpoints included progression-free survival (PFS), overall survival (OS), and adverse effect (AE). Results: From December 2021 to December 2022, 31 patients (median [range] age, 53 [18-69] years; 20 [64.5%] male) were enrolled. 29 were evaluable for objective response, and the ORR and DCR were 31.03% (95%CI, 17.28-49.23%) and 82.76% (95%CI, 65.45-92.4%), respectively. With a median follow-up duration of 6.3 months (range, 0.8–14.0), the median PFS for all 31 patients was 6.9 months (95% CI, 2.62-11.17). The median OS was not reached. Treatment-related AEs of any grade occurred in all patients. The most common AEs included nausea/vomiting (88.46%), anemia (23.08%), leukopenia (19.23%), venous thrombosis (15.38%), hand-foot syndrome (11.54%) and elevated alanine aminotransferase or aspartate aminotransferase (11.54%). The most frequent ≥ grade 3 AEs were leukopenia (11.54%) and thrombocytopenia (7.69%). 2 serious AEs (1 left heart failure and 1 intestinal obstruction) were recorded. No treatment-related death occurred. Conclusions: This study suggested that anlotinib combined with anthracycline and ifosfamide followed by anlotinib maintenance demonstrated encouraging efficacy with a manageable safety profile in the first line treatment of patients with advanced STS. Clinical trial information: ChiCTR2100054711 .
Correlation of homologous recombination deficiency (HRD) score with response to the first-line treatment of immune checkpoint inhibitors plus chemotherapy in non-small cell lung cancer.
Authors: Guo Li, Lili Zeng, Lingling Wang, Yuhang Cai, Chenghao Xuan, Dian-Sheng Zhong, Linlin Zhang
Journal: Journal of Clinical Oncology (2023)

e21121 Background: Homologous recombination (HR) gene mutations were reported to be associated with efficiency of immune checkpoint inhibitors (ICIs). However, up to date, no recognized standard has been set up for definition of HR mutation (+), which limited its clinical application. Homologous recombination deficiency (HRD) score reflects genomic scar induced by HR genes alteration and disfunction. Thus, it may be worth to explore whether HRD score could predict the efficacy of ICIs-based therapy. Methods: We collected tumor tissues from metastatic non-small cell lung cancer (NSCLC) patients who received first-line treatment of ICIs combined with platinum-based chemotherapy. HRD score testing were carried by BGI genomic scar analysis kit, which calculates the sum of loss of heterozygosity (LOH), telomeric allelic imbalance (TAI), large-scale state transitions (LST) scores, and corrected by ploidy of tumor samples, through next generation sequencing(NGS) data. The association of HRD score and response to ICIs plus chemotherapy were analyzed. Results: 22 EGFR/ALK wild-type metastatic NSCLC patients were included. The average HRD score was 24.57, varying from -26.37 to 92.34. Threshold traversal was performed based on analysis of the progression free survival (PFS) data from the included NSCLC patients. HRD score 31 or more were define as HRD (+). Kaplan-Meier PFS Survival analysis showed prolonged median PFS (mPFS) in HRD (+) versus HRD (-) NSCLC patients (N/A vs. 7.0 ms, Log-rank P = 0.029; HR 0.20, 95%CI 0.04-0.96, likelihood-ratio P = 0.03). The objective response rate (ORR) was 45.5% (5/11) in HRD(+) versus 27.2% (3/11) in HRD(-) patients. In patients with PD-L1 TPS≥1% (22C3), the mPFS was N/A vs. N/A, and the ORR was 75.0% (3/4) vs. 37.5% (3/8), in HRD (+) vs. HRD(-) patients. In patients with PD-L1 TPS &lt; 1% (22C3), the mPFS was 8.5 ms vs.2.0 ms (Log-rank P = 0.0085; HR 0.08, 95%CI 0.01-0.82, likelihood-ratio P = 0.02), and the ORR were 28.6% (2/7) vs. 0%(0/3), in HRD (+) vs. HRD(-) patients. Conclusions: In addition to PD-L1 expression level, HRD score would be a potential promising biomarker for predicting the efficiency of ICIs plus platinum-based chemotherapy in NSCLC patients.
Real-world treatment patterns of non-small cell lung cancer in an Indian hospital.
Authors: Gavin Miyasato, Vamsi Chandra Kasivajjala, Mohit Misra, Kiran Kumar, Chitrang Shah, Howard S Friedman
Journal: Journal of Clinical Oncology (2023)

e18604 Background: The circumstances regarding lung cancer in India are similar to many countries around the world – it is one of the most commonly diagnosed cancers with many treatment options available. India, however, relies heavily on an out-of-pocket healthcare payment model in which patients are often directly responsible for the majority of these treatment costs. This paradigm makes many of the newer generation of medications financially inaccessible for most Indians. In this research, we aimed to understand the current treatment patterns of non-small cell lung cancer (NSCLC) from an analysis of Indian hospital data, as a way to contextualize the real-world treatment situation. Methods: Electronic Medical Record (EMR) data was sourced from a major cancer hospital located in India’s national capital region. Using the Querent health analytics platform, EMR data across 5 years (2017-2022) were analyzed. Demographics, disease characteristics, and treatment patterns were identified through a combination of structured and unstructured data including data from registration, laboratory, radiology, diagnosis, procedure, pharmacy, and clinical notes. Results: 1,227 unique patients with NSCLC were observed in the hospital over five years, with an average (SD) duration of observation time of 12.1 (15.4) months. The patients were, on average (SD), 59.0 (11.2) years old and were more likely to be male (69.4%). Most patients were in later cancer stages, with a distribution of I (3%), II (2%), III (13%), and IV (82%). Among those with metastatic NSCLC, 773 (76%) received cancer treatment at the hospital, with 52% receiving surgery, 5% radiotherapy, and 88% anti-cancer medication. The most commonly administered medications were chemotherapies (carboplatin (52%) and pemetrexed (38%)). Targeted therapies were administered in 55% of patients. Conclusions: Only about half of all metastatic NSCLC patients received targeted cancer therapy. This proportion pales in comparison to targeted therapy utilization rates observed in the US and Europe, indicating the need to address the affordability issues that hamper patient access to these medications. Increased adoption of advanced therapeutics could lead to improved outcomes for many patients in India.
Bringing the teaching close to home: Implementation of a near-peer model for an introductory hematology-oncology fellowship lecture series.
Authors: Jonathan L Berry, Matthew L Chase, Reed Drews, Jason Freed, Rushad Patell, Deepa Rangachari
Journal: Journal of Clinical Oncology (2023)

11025 Background: Hematology/oncology fellowship has a steep learning curve. Foundational knowledge at the start of fellowship is essential, given limited exposure to key disease-specific concepts in prior training. We have previously employed an expert faculty-led “introductory boot camp” during the first 2 months of fellowship training. Trainees provided feedback that this was not best meeting fellows’ needs. We hypothesized that a near-peer teaching model, led by senior fellows, would better align lecture content and scope with the needs of new fellows and improve senior fellows’ mastery of clinical knowledge and comfort with teaching skills. Methods: Using a constructivist theory of learning, we selected the most relevant topics from the curriculum and assigned each senior fellow 1-2 hour-long sessions on clinical areas of interest, paired with expert faculty. A one-hour workshop on lecturing techniques and instructional design was held for all senior fellows. Educational sessions led by senior fellows and expert faculty occurred July-September 2022 in a hybrid format. An IRB-exempt anonymous survey was sent to participating fellows and faculty regarding effectiveness of the educational sessions and the process of preparing to lead sessions. Results: 15 of 17 fellows (88%) and 12 of 15 faculty (80%) completed the survey. Overall, 71% (95% CI 33-82) of fellows and 75% (95% CI 43-95%) of faculty felt the new series was taught at an appropriate level for new fellows. All fellow respondents felt the approach was helpful for clinical practice and board preparation. All participating senior fellows felt equipped to teach and that the exercise improved confidence in the content and their teaching skills. No fellows proposed a return to the prior model, and 80% of faculty felt the near-peer approach should be continued in future years. Qualitative analysis of narrative responses identified several strengths, including emphasis on focused, introductory frameworks and the generation of living resources for future reference. Areas identified for future improvement include providing more guidance and structure for pre-lecture faculty-fellow preparations. Conclusions: A near-peer model of introductory lectures is feasible to implement, produces improved satisfaction with the curriculum, and can be a means of presenting foundational content in hematology and oncology concordant with the learners’ needs. This method has important implications for developing learner-concordant, expert-driven curricula in large and rapidly changing content areas within hematology/oncology.